A study published in the British Journal of General Practice found that increasing the number of same-day appointments by 10% actually lowered the number of satisfied patients. Due to the findings, researchers from the University of Bristol said practices should be wary when increasing the number of same-day appointments to meet access targets.
Phone calls to a medical practice are usually numerous and labor-intensive. New staff members are often hired to help handle the call volume, many times with limited formal training on practice policies and procedures. The results of these fast hires can be disastrous to a practice.
Start by reviewing procedures and tracking the number and type of phone calls that come into the practice. Listen to your staff members conducting the call to determine how to restructure this function.
Since phone calls are an integral part of a patient's satisfaction with the practice, management should develop a telephone training program for new employees. This program can also be used as a refresher course for experienced staff members.
The following are topics to include in your manual:
How to appropriately answer a telephone call. For example, refer to a script that includes answering with the practice's name, introducing yourself, and asking, "How can I help you today?"
How to deal with angry patients. Create a script that reassures patients that you will be able to answer their questions and refer them to the appropriate resource to resolve their issue.
How to handle patients' individual requests, such as leaving a message with a provider or asking for guidance with a medical emergency. Staff members should have a list of nearby medical centers, hospitals, pharmacies, and other resources for which to refer a patient.
Practice managers should conduct staff training before or after office hours. This gives staff members a better chance to focus on the materials presented and to more quickly learn and perform the functions.
Training programs should be designed with a positive spin to improve and update efficiencies within the practice, rather than a forum that tells staff members they are doing the job incorrectly.
Have a planned agenda, along with supporting documentation and handouts. Start the session on time and factor in a short or long break depending on the length of the session. Allow enough time at the end of the program for staff members to ask questions and share their concerns.
This article was adapted from one that originally ran in the August 2008 issue ofThe Doctor's Office, a HealthLeaders Media publication.
There has long been an institutional bias in medical education against primary care. Many doctors we have spoken with have recounted how they were steered away from primary care by preceptors in medical school. The general sentiment conveyed to medical students long has been that surgical and diagnostic specialties are for the most accomplished students and that primary care is for the less accomplished.
This bias has been combined in recent years with a growing disparity in income between primary care physicians and specialists. The result is an acute shortage of primary care doctors, and a particularly severe shortage of general internists.
Less than 30% of medical students selecting internal medicine residencies now plan to practice primary care, according to an Association of American Medical Colleges survey. The majority are opting to become hospitalists or internal medicine sub-specialists.
The recruitment challenge
Internal medicine therefore is the most challenging specialty to recruit today. Finding a traditional general internist —one who rounds on patients in the morning, maintains an office practice, then rounds again in the evening—is the recruiting equivalent of scaling Mount Everest.
While an internist practicing as a hospitalist might work 40 hours a week and, with a rotation of seven days on and seven off, enjoy 20 weeks of vacation a year, a traditional internist typically will work 60 hours a week and have four weeks of vacation. On top of this, a hospitalist is likely to earn several thousand dollars more a year than a traditional internist.
The traditional internal medicine model is close to moribund, since very few candidates are interested in this practice style. This obliges hospitals to establish hospitalist programs so that they can offer internists outpatient-only settings, which are usually more attractive than traditional internal medicine settings.
Even the outpatient-only model, however, may not be as attractive to internists as working as a hospitalist. Hospitalists typically see 15 or fewer patients per day, while internists often see 25 or more. In addition, hospitalists are employed by a hospital or a group, while many internal medicine settings feature independent practices where physicians must contend with reimbursement and other practice management issues.
Many physicians prefer the security of employment today to the uncertainty of private practice and we advise clients to employ internists where possible (some states prohibit hospitals from employing physicians, however.)
Focusing on patients
The attraction of internal medicine—whether traditional or outpatient only—is patient rapport. Hospitalists see acute patients who have "interesting" cases, but such cases can be draining when they are all the doctor sees. Hospitalists also tend to get barraged on weekends when hospital staff is reduced and they must manage heavy patient loads. In addition, hospitalists enjoy no patient continuity. Once discharged from the hospital, patients go back to their general internists.
An internist, by contrast, will see well patients and can follow patients over time. The emotional rewards of general internal medicine still trump the "shift work" of hospital practice for some physicians. While the emotional appeal of internal medicine will attract some candidates, today’s market requires that incentives be competitive.
A competitive internal medicine opportunity will feature balance—a reasonably high salary ($160,000-$170,000 for outpatient only, $180,000 - $200,000 for traditional), combined with 4-5 weeks of vacation/CME, a turn-key setting that does not require a long ramp-up time, minimal night and weekend call, employment, and, where appropriate, educational loan forgiveness.
As long as reimbursement is weighted toward procedures and away from consultative practice, and as long as medical school bias exists, the supply of primary care physicians, internists in particular, will be constrained. This challenge can be met by aggressive finding candidates who are attracted to the emotional rewards of internal medicine—and emphasizing those aspects during the recruitment process—and by offering incentives packages that are balanced and competitive.
Allen Dye is Vice President of Marketing and Troy Fowler is Vice President of Recruiting for Merritt, Hawkins & Associates, a national physician search and consulting firm. They can be reached at adye@mhagroup.com and tfowler@mhagroup.com.This column originally ran in the September 2008 issue ofPhysician Compensation & Recruitment, a HealthLeaders Media publication.
As costs continue to rise and overall profit margins shrink for physician practices, many groups are forming partnerships and looking to other forms of consolidation and collaboration to bring in additional revenue, expand market share, and generally make it easier to navigate the healthcare minefield.
However, these financial arrangements are under a lot of scrutiny, and setting them up can be a major headache. A physician can barely sneeze these days without implicating the Stark self-referral law, the anti-kickback statute, or a host of other federal regulations. I'm being a little hyperbolic, but if other physicians are in the room during the sneeze, it might be a good idea to document their reactions.
Just this week, for instance, the OIG took another hard stance against certain joint ventures between physicians. The advisory opinion related to a contractual joint venture between two practices—one providing cancer treatment services in a free-standing facility and the other a urology group.
The cancer center offers intensity-modulated radiation therapy (IMRT) to treat prostate cancer, and the urologists who refer patients for IMRT wanted to bring the service in-house through a series of written agreements allowing the urologists to lease the space, equipment, and personnel services necessary to perform the procedure.
It would have been a mutually beneficial arrangement: The urologists would get access to the equipment they need, and the cancer center would bring in some additional revenue from the equipment rent and reimbursement for other administrative expenses.
But the OIG argued that the arrangement could potentially violate the anti-kickback statute. As healthcare lawyer David Harlow points out, this isn't a drastically new direction for the OIG; it has issued three other advisory opinions taking a similarly tough stance against this type of contractual joint venture. This case is a reminder, however, that you must carefully plan these partnerships and never assume that an arrangement is permissible unless you have solid evidence to back it up. Federal and state governments certainly aren't afraid to prosecute for fraud or improper self-referral.
That doesn't necessarily mean the partnerships aren't worthwhile. But the legal and administrative costs can be a burden, particularly for small practices. That's part of the reason we're seeing a lot of mergers and growth in group size—bigger organizations more often have the business and legal experts to deal with requirements like assessing fair market value and scrutinizing contracts.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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Denver-based hospital system Centura Health will continue operating Ask-A-Nurse, its free call-in nurse service. In early July, Centura said it would close the service due to financial pressures. But Arlen Reynolds, Centura Health chief operating officer, said Centura was deluged with calls and e-mails from the community voicing disappointment about the move. Leaders met to reconsider the issue and decided to continue the service.
Panelists at a healthcare forum agreed that Pennsylvania's healthcare system has serious gaps, but they had little consensus about how to improve it. The discussion repeatedly turned to the question of how much it will cost to expand insurance coverage, and who would pay for it. The goal of the Health for Life community forum was to look for ways to advance healthcare reform in the state.